As we conclude our standard re-negotiation process with UnitedHealthcare (United), below are changes which will impact some of our patients and plans starting on Nov. 1, 2024.
Despite WellSpan’s months-long efforts to reach a renewed agreement for patients with UnitedHealthcare Commercial PPO and HMO insurance, we were unable to find a mutually acceptable solution with UnitedHealthcare. As a result, WellSpan Health is no longer a participating provider for UnitedHealthcare Commercial PPO and HMO plans as of Nov. 1, 2024.
For patients with UnitedHealthcare’s Medicare Supplement plans, which are secondary to traditional Medicare insurance coverage, these plans will continue to be accepted by WellSpan; they are not impacted by the Medicare Advantage plan changes occurring Nov. 1, 2024, or Jan. 1, 2025.
Q. What is the outcome of the contract negotiations with UnitedHealthcare?
A. For patients with United Commercial PPO and HMO insurance, despite significant effort, United was not willing to work with us to find a mutually acceptable solution before the contract renewal date that would provide a sustainable way forward for our organization. As a result, WellSpan Health no longer accepts UnitedHealthcare Commercial – PPO and HMO – Insurance as of Nov. 1, 2024. We want to ensure you are informed of your options for ongoing care needs.
Q. What UnitedHealthcare Commercial plans are impacted by this change?
A. This includes all UnitedHealthcare Commercial plans, both HMO and PPO plans.
Q. Starting Nov. 1, 2024, how will my coverage be affected?
A. As of Nov. 1, 2024, here is how your coverage will be affected:
- Starting Nov. 1, 2024, WellSpan will no longer be an in-network provider.
- If you are a United Commercial PPO plan member, you will still be able to see your WellSpan physician and receive care at our facilities; however, your visit will be out-of-network and you may incur higher out of pocket costs. WellSpan offers flexible payment options to help you pay for out-of-pocket costs for which you may be responsible.
- If you are a United Commercial HMO plan member, any services scheduled after Nov. 1, 2024, will need to be redirected. You can work directly with United to find a participating provider and location to reschedule any procedure or service.
- Please check your insurance ID card to find your plan type (PPO or HMO).
Q. Why weren’t WellSpan and UnitedHealthcare able to reach an agreement?
A. As the region’s largest community-based non-profit health system, WellSpan is committed to keeping healthcare affordable for our patients and communities we serve by negotiating the appropriate contracts with insurance companies. As part of our standard negotiation process with the insurance companies, WellSpan desires to come to an agreement with insurers before their contract renewal date. Over the last two years, WellSpan and other healthcare systems in Pennsylvania and across the nation have experienced significant inflation—18% overall—on the costs of staffing, drugs, and supplies, resulting in higher costs to deliver healthcare services to our community. We asked United for reasonable rate increases to effectively meet the ongoing healthcare needs of the community and provide exceptional care that our patients have come to expect. United was unwilling to do so. UnitedHealth Group, UnitedHealthcare’s parent company, is a for-profit, publicly traded health company that posted annual revenue of $371.6 billion in 2023 and net profit of more than $22 billion. UnitedHealthcare is an aggressive insurance company that creates significant administrative burdens for our physicians and care teams with undue delays and denials of care for patients which prevents timely treatment and recovery.
Q. Did WellSpan inform me of the outcome of contract discussions?
A. Yes – WellSpan sent an initial letter to your mailing address on record in September 2024 to notify you of the impending coverage changes. A follow up letter has been sent to notify patients we will not be participating with UnitedHealthcare Commercial insurance plans after Oct. 31, 2024.
Q. Can patients use their current UnitedHealthcare Commercial insurance until November 1, 2024?
A. Yes, any covered services received prior to November 1, 2024, will be submitted to their plan for payment.
Q. If a claim is not paid by the patients’ plan before November 1, 2024, will they be responsible for the costs?
A. Services provided before Nov. 1, 2024, will be submitted to the current insurance plan for payment. Only amounts which are not covered by the patients’ insurance carrier would need to be paid personally.
Q. Are patients able to continue to access emergency care?
A. Yes, we continue to welcome any patient needing emergency care services across our WellSpan Emergency Department locations.
Q. If patients have further concerns or questions about in network care options, who should they be referred to?
A. Patients may contact their insurance plan or employer to discuss questions and concerns about participating providers in their network.
Q. Will WellSpan transfer my medical records if I have to select a new provider for services?
A. Requests for transfer of medical records can be made to the WellSpan Release of Information Department by completing the Authorization to Use or Disclose Health Information form available on wellspan.org. Visit Medical Records to locate the form – available in English, Spanish and Haitian Creole. Many components of your electronic health record are also available via our secure patient portal – MyWellSpan.
Q. Will WellSpan still be able to see me after Nov. 1, 2024, if I am in ongoing treatment?
A. Continuity of care under PA statute allows for patients to continue to be seen for ongoing treatment up to 60-days after a provider ceases to participate with a payor. Patients should be referred to UnitedHealthcare member services to request an application for continuity of care.
